RT Journal Article
SR Electronic
T1 Haemorrhagic stroke in term and late preterm neonates
JF Archives of Disease in Childhood - Fetal and Neonatal Edition
JO Arch Dis Child Fetal Neonatal Ed
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP F48
OP F53
DO 10.1136/archdischild-2013-304068
VO 99
IS 1
A1 Christie J Bruno
A1 Lauren A Beslow
A1 Char M Witmer
A1 Arastoo Vossough
A1 Lori C Jordan
A1 Sarah Zelonis
A1 Daniel J Licht
A1 Rebecca N Ichord
A1 Sabrina E Smith
YR 2014
UL http://fn.bmj.com/content/99/1/F48.abstract
AB Objective Few data regarding causes and outcomes of haemorrhagic stroke (HS) in term neonates are available. We characterised risk factors, mechanism and short-term outcomes in term and late preterm neonates with acute HS. Design Prospective cohort. Setting Single-centre tertiary care stroke registry. Subjects Term and late preterm neonates (≥34 weeks gestation), born 2004–2010, with acute HS ≤28 days of life were identified, and clinical information was abstracted. Short-term outcomes were assessed via standardised neurological exam and rated using the Paediatric Stroke Outcome Measure (PSOM). Results Among 42 neonates, median gestational age was 39.7 weeks (IQR 38–40.7 weeks). Diagnosis occurred at a median of 1 day (IQR 0–7 days) after delivery. Twenty-seven (64%) had intraparenchymal and intraventricular haemorrhage. Mechanism was haemorrhagic transformation of venous or arterial infarction in 22 (53%). Major risk factors included congenital heart disease (CHD), fetal distress and haemostatic abnormalities. Common presentations included seizure, apnoea, and poor feeding or vomiting. Acute hydrocephalus was common. Mortality was 12%. Follow-up occurred in 36/37 survivors at a median of 1 year (IQR 0.5–2.0 years). Among 17/36 survivors evaluated in stroke clinic, 47% demonstrated neurologic deficits. Deficits were mild (PSOM 0.5–1.5) in 9/36 (25%), and moderate-to-severe (PSOM ≥2.0) in 8/36 (22%). Conclusions In our cohort with acute HS, most presented with seizures, apnoea and/or poor feeding. Fetal distress and CHD were common. Nearly two-thirds had intraparenchymal with intraventricular haemorrhage. Over half were due to haemorrhagic transformation of infarction. Short-term neurologic deficits were present in 47% of survivors.